Provider Demographics
NPI:1376967745
Name:YOUR METRO DR. IMMEDIATE CARE CENTER
Entity Type:Organization
Organization Name:YOUR METRO DR. IMMEDIATE CARE CENTER
Other - Org Name:YOUR METRO DOCTORS MEDICAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-732-0089
Mailing Address - Street 1:323 CROMWELL AVENUE
Mailing Address - Street 2:C/O CVS MINUTE CLINIC
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067
Mailing Address - Country:US
Mailing Address - Phone:646-732-0089
Mailing Address - Fax:
Practice Address - Street 1:323 CROMWELL AVENUE
Practice Address - Street 2:C/O CVS MINUTE CLINIC
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067
Practice Address - Country:US
Practice Address - Phone:646-732-0089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037321261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care